Thursday, June 13, 2013

How to Quell Physician Discontent with EMRs

How do you quell physician discontent with Electronic Medical Records (EMRs)?

Easy.

Have the leadership of your physician organization interview the National Coordinator for Health Information Technology, then make sure your physicians read the spin. This is one of my favorite excerpts:

Q: Many physicians are not seeing the expected financial return on
investment after EHR implementation. Why is that?

A: How you implement the technology has a lot to do with the results you achieve. (ed: Now, note how he dodges the question) But the bigger issue is how the compensation system is designed. If physicians are operating in a fee-for-service environment, then many of the gains of EHRs -- for instance, in quality, safety and patient engagement -- aren't reflected in revenue. Physicians are doing more work and delivering better care and service, but the added value is not reflected in the reimbursement. (ed: Okay, that's what we said: we're seeing lower pay, not higher, despite doing more and more meaningless data entry work with EHRs. We are often not finding return on our investment with the additional work. Why are you now addressing nebulous issues with physician payment reform? Could you stick with the question, please?)

We've been an advocate for making sure that when value is added, it's reflected in increased physician reimbursement whether it's through the patient-centered medical home (PCMH) setting (ed: Alas: no. It is impossible for the Coordinator to stick to the question. Now we're on to Value-Based Purchasing. WTF? Doctors aren't PURCHASING value, dammit, we're providing CARE!), value-based purchasing or part of an accountable care structure. That's where the ability to manage information -- not just for individual patients but for populations (ed: Remember dear doctor, it's not about you and your patient, EHRs are about the population manipulation! Huh?)-- becomes an absolute necessity, because in those models, it's not a question of whether there's a return on investment with electronic health records. (ed: Yes, dear Coordinator, in case you forgot, this WAS the original question) A physician can't function in those models without an EHR. (ed: Really? Since when?)

If you can stomach more, go on over and read the whole thing. (And consider leaving them a comment about how you really feel about this spin).

The story links to a video produced to show how to integrate the EHR into the exam office visit ( http://www.youtube.com/watch?v=LZAqeJtpzEY ). Sounds like a great topic, doesn't it? Watch the video -- it is horrible, demeaning and simplistic. It actively mocks the obese, bald and anxious. Hard to believe that someone in a leadership position would promote this junk.

Mostashari is the worst. I was at a talk he was giving where some physicians tried to ask very polite but direct questions. He absolutely refused to even answer..."next question". This man is a pretentious and condescending wonk who could not cut it as a practicing physician so he chose to rule us. That is the irony of the current system. Failure brings promotion. This is your healthcare system--this is your government.

It seems ONC feels that EMR is not designed for FFS, rather it should catalyze an entire shift in medical practice ? Most of these 'authorities' do not take care of patients anymore, if they ever did. The title looks good on their resume for the next insurance company or IT firm that highers them (and the patient inevitably pays for it..My $.02

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.